Question:

How do you code for diffusion-tensor imaging (DTI) and diffusion-weight¬ed imaging (DWI) when they are performed with magnetic resonance imaging (MRI) of the brain? Are there specific codes to describe this imaging?

Answer:

When DTI is performed in the same setting as a routine brain MRI, the brain MRI code should be reported only once. However, in the unusual circumstance in which a patient had a routine brain MRI performed and a re¬quest is later received to specifically perform DTI at a separate distinct session that includes re-imaging the brain, it would be appropriate to report each study using a brain MRI code because these services occurred during two separate scanning sessions. DTI involves both scanning the patient and a large amount of post-processing. If the post-processing is done from stored images at a later time this is not a separate session. While DTI does include more extensive post-processing than standard DWI, it is not reported separately or with modi¬fier 22.
DWI is considered a routine sequence of MRI, such as fluid-attenuated inversion recovery (FLAIR), and should not be reported separately. A DWI sequence typically adds minimal additional time to both image acquisition and physician interpretation and, when performed, should be considered an inherent part of the base MRI study.
Although this reporting method reflects the intent of CPT®, third-party payers may request that you report these services differently. Eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer. You may wish to contact them about specific reporting guidelines (i.e., appropriate modifier).


CPT® is a registered trademark of the American Medical Association.

This question was answered in the September edition of our Radiology Compliance Manager. For more hot topics relating to radiology services, please view our store, or call us at 1.800.252.1578 ext. 2.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.